Settings for Health

Education

“Be kind, for everyone you meet is fighting a great

battle”
Philo of Alexandria
 Goal of Health Education

Health promotion -- process of enabling

people to increase control over, and to
improve their health.
Why are settings important to
the health education field?
 Settings are Major Social
Structures for…
1. Health education “practice”
– Programs can be implemented
– Populations can be reached

2. Health education “research”

– Programs can be tested
• Feasibility (practicality)
• Effectiveness/Efficacy
• Areas for improvement
 Health Education Practice

Setting
Assessi Goals Developin Implementi Evaluating
g an ng the
ng and Interventio Interventio
the
Needs Objectiv n Results
n
es

The delivery of health education practice,

depends on the setting
Health education is offered in
a variety of settings
 Grouped into 5 Major Settings
• Schools

• Healthcare facilities

• Public health departments

• Community-based organizations

• Businesses/worksites
Health Education in School Settings
 School Health Education
• Primarily involves instructing school-
age children and youth about health &
health-related behaviors

• Strategies, activities, & services

designed to promote students’
physical, emotional, and social
development
– All of which affect student learning

• Potential to impact students is

tremendous
– Nearly 54 million students or about
25% of the US population are
enrolled in public and private
schools
Some History… • 1837, Horace Mann, Secretary of
Massachusetts Board of Education,
called for mandatory programs of
hygiene
– Hygiene education

• 1850, Lemuel Shattuck’s report called

for teaching of physiology (bodily
processes)

• 1880–1890, all states passed law

requiring teaching on evils of alcohol,
narcotics, & tobacco
(pressures from temperance mvmt)

• 1964: School Health Education Study –

SHES
– To identify critical health issues and
content areas to focus on
 School Health Education
Study

• Landmark study in transforming

health education as practiced in
American public schools

• Health is just not “physical”, but

shaped also by behavioral,
emotional, and social development

• Responsible for establishing the

value of comprehensive health
education rather than separate
disease-specific units
Some more history…

• 1978: Office of
Comprehensive School
Health established

• What does comprehensive

school health mean?
 Key Elements of
Comprehensive Health Education

Health Behaviors
Currently…

• In the U.S. ~ 40 states

require the teaching of
health education

• Are there health

education standards in
this setting?
School Health Education Standards

• Written expectations for what

teachers and students
should know and be able to
do by grades 2, 5, 8, and 12
to promote health

• Why are standards

important?

•Standards provide a framework for curriculum

development, instruction (practice), and student
assessment (evaluation) in health education
Where does health education
fit in within existing school
curricula (instruction)?
 CDC has advocated for:
Coordinated School Health
 Health Behaviors Targeted in
School Health
CDC’s 6 Critical
Health Behaviors
• Alcohol & drug use
• Injury & violence (including seatbelt use and
suicide)
• Tobacco use
• Nutrition
• Physical activity
• Sexual behaviors
How do these behaviors compare to “Rules for good health”
of the past (19th Century)?
Rules of Good Health* - 1922

• Take a full bath more than once a week

• Brush teeth at least once a day
• Sleep long hours with windows open
• Drink as much milk as possible, no coffee or tea
• Eat some vegetables or fruit everyday
• Drink at least four glasses of water a day
• Play part of every day outdoors (sun)
• Have a bowel movement every morning

*Regney (1922)
Has School Health Education
been effective?
 Research Says…

• Numerous studies on school health

education have been conducted during past
two decades (throughout US schools)

• Results: comprehensive school health

education curricula significantly reduces
several types of risk behaviors
simultaneously in both:
– Elementary grades (4th-7th) & Secondary
grades
 Advantages & Disadvantages
• Captive audience • Budget is limited
• Learner in • HE considered a
developmental years, fringe subject (not as
means impact of important as english,
health education may math, or hx) so its’
be significant served last
– Mold health values • Unqualified
• Standards instructors
Health Education in Community Settings
 Community Health Education Practice
• Health education has a long
tradition in communities

• Focus: community change &

development in terms of improving
health outcomes (reducing health
disparities)

• Types of community agencies:

– Voluntary (ACS, AHA, ALA)
– Governmental public health
agencies (state/county health
departments)
 Health Education Practice in
Communities
• Educate: Information dissemination
• Raise Awareness: Keeping pops informed
• Prevention Focus: Morbidity/unhealthy behavior
• Health Promotion: healthy behavior & policies
• Reduce Disparities: target special populations
• Provide Resources: materials vary (print, PSAs,
radio, books, flip charts – trainings, etc.)
• Ensure Cultural Diversity: address literacy
(readability and language needs)
 Health
Education
Focus in
Communities

LA County
Health
Department
Two Critical Public Health Issues

Disasters

Infectious
Diseases
 Emergency Preparedness &
Response Unit

The mission is to
prevent and mitigate
the public health
consequences of
natural or intentional
emergencies for Los
Angeles County
residents
 Health
Education

Promoting
Safe
Behaviors
 Health
Education

Raising
Awareness
 Health Education Material
“Target Special Populations”
Children
 Health
Education
Material

Target
Special
Populations
People with
Disabilities
 Health
Education
Material

Ensure
Cultural
Diversity
 Health Education

Resources

Cultural Diversity
Bookmark
Vietnamese

Available in: English, Spanish, Arabic,

Armenian, Chinese, Farsi, Korean, Khmer,
Russian, Tagalog, Thai
Just Be Ready: Prepare Together
 Communicable
Disease Control Unit
Amebiasis Hantavirus Pulmonary Meningitis Streptococcal Infections
Anisakiasis Syndrome (HPS) Pertussis: Whooping Tetanus
Antibiotic Resistance Head Lice Cough
Trichinosis
Anthrax Hepatitis A Plague
Typhoid Fever
Avian Flu Pneumococcal Disease
Hepatitis B Vibriosis
Bioterroism Psittacosis
Hepatitis C West Nile Virus*
Botulism Q-Fever
Influenza: Seasonal Rabbit Fever
Denque Fever
Brucellosis Influenza: A H1N1* Rabies

Campylobacteriosis Influenza: Pandemic Relapsing Fever

Chicken Pox Kawasaki Syndrome Reye Syndrome *Current Priorities

Cholera Legionellosis Rheumatic Fever

Clostridium Difficile Leprosy Rocky Mountain

Spotted Fever
Coccidioidomycosis Leptospirosis
Rubella (German
Cryptosporidiosis Listeriosis,Nonperinatal Measles)
Diphtheria Listeriosis, Perinatal Salmonellosis
E. coli O 157:H7 Lyme Disease Scabies
Encephalitis Malaria Severe Acute
Food Borne Disease Measles (Rubeola) Respiratory Syndrome
(SARS)
Giardiasis Mumps
Shigellosis
Haemophilus Murine (Typhus)
Influenzae type b Smallpox
 Health
Education
Material

Focus on
Prevention
 Health
Education
Material

Educate
 Health
Education
Material

Raising
Awareness
Health Education
Material

Promoting Health
Behaviors

Immunization
 Health
Education
Material

Promoting
Health
Behaviors
 Health
Education
Material

Target
Special
Populations
 Health
Education
Material

Target
Special
Populations
 Health
Education
Material

Ensure Cultural
Diversity

Available in: English, Spanish,

Arabic, Armenian, Chinese, Farsi,
Korean, Khmer, Russian,
Vietnamese, Tagalog, Thai
 Health
Education
Material

Resources

Bookmark

Settings: Community/Faith Based

organizations; Medical Community;
Individuals and Families; Businesses
Health Education in Worksite Settings
 Worksite Health Education
• A combination of educational,
organizational and environmental activities
designed to improve the health & safety of
employees & their families
• Goals: reduce health care costs & improve
productivity
• Currently, there is no mandate for such
programs as there is with occupational
safety
• What about standards of practice?
• There are professional guidelines, such as
those of the Association for Worksite
Health Promotion, BUT, they are not
widely disseminated
 Worksite Health Education Practice

• Programs vary greatly from site to site

• Majority have a “wellness focus”

• Examples:

– Conducting educational (prevention) classes

– Conducting screenings & personal training

sessions
 Growth of Worksite Wellness
• 1992 National Survey of Worksite Health
Promotion (representative sample of private-
sector US organizations employing 50+
employees) indicated:
– 81% of worksites offered health promotion
in comparison to 66% in 1985
– 52% offered at least 1 preventive screening
service in comparison to 30% in 1985
– Majority of health education activities in:
• job hazards/injury prevention (64%)
• exercise/physical fitness (41 %)
• smoking control (40%)
• stress management (37%)
• alcohol and other drugs (36%)
Effectiveness?
• The extent to which
employers adopt programs
and implement them with
fidelity is not known.

• Issue: worksites vary greatly

in their budgets for health
promotion and professional
preparation of staff.
Health Education in Health Care Settings
 Health Education in Health Care Settings

• Large population reach: ~85% of

US population see a health
provider in a given year

• Variety of settings: hospitals,

clinics, home health agencies,
insurance companies, dental
offices
 Health Education Practice in
Health Care Settings

• Patient education: 1-on-1 with

patients
• Explain diagnosis and any tests
• Teach patients about lifestyle
changes necessary to manage
disease
• Provide “continuing care” (long-
term) services, such as in-home
healthcare or support groups, that
will assist patient in managing an
illness
Why are health care settings critical
venues for delivering health
education?
 Unique Characteristics
• Health care settings enhance the efficacy of
health education practice…b/c:
– (1) improved health is the primary objective
of all activities in this setting, and
– (2) health care providers are generally
considered to be credible sources of health
information

• This combination of factors: (a) persons who

are more than usually receptive and attentive
to health information (patients) and (b)
interacting with professionals who are trusted
and respected (health care providers)

– creates an environment conducive to

effective health education
 Research on Health Care Settings
• Studies consistently show that:
– For patients with chronic or acute
conditions, health education is effective
in terms of reducing morbidity and
mortality
– Saves $: each dollar spent on HE saves 4
dollars in other health-related costs
– Interventions vary, but typically include:
reductions in dietary fat, mammography,
family planning, immunizations,
cholesterol screening, & changing
inaccurate perceptions of health risk
• What’s lacking?
Screening for the Identification of
Substance Use
 Major Public Health Challenge
• Striking disconnect between the proportions of individuals reporting
misuse of substances or diagnosed with substance
abuse/dependence and those receiving treatment

In Treatment ~1.8 million

Abuse/Dependence ~22.3 million

Misuse of Illicit Drugs ~ 19.9 million

Misuse of alcohol ~ 126.8 million

• Little attention has been paid to the latter “risk groups” which often
come into contact with health care settings (esp. emergency rooms)
 Research of AOD Identification in
Health Care Settings
• CASA Health care study:
included 650 primary care
physicians with over 500 patients
in tx for chronic diseases:

• Findings:
– LESS than 1/3rd of PCP’s Screen for
Substance Use
– ~50% of patients said “PCP asked
nothing of AOD use”
– 10% said “PCP asked, but did
nothing”

Missed Opportunity: National Survey of Primary Care Physicians and Patients, the
National Center on Addiction and Substance Abuse (CASA) @ Columbia University, NY
2000
Health Education in Higher Education

• Health educator in university health

service or wellness center

– Plan, implement & evaluate

programs for students

– Resource library, peer education

programs
• CSUN: Health Center (Student Live)
Assessment &
Diagnosis
 ACHA - National College Health
Assessment
• Developed in 1998 by
college health education
professionals

• Helps with -- problem

analysis of health issues
faced by students for
program development

• Why? Results linked to

academic success
NCHA: Health Education Areas
• General health status
• Alcohol and other drugs
• Violence
• Weight, nutrition, exercise
• Sexual behaviors,
perceptions, contraception
• Mental and physical health
• Other factors affecting health
– Vary: insurance, sleep, credit card
debt
 Results Inform Health Education
Planning for Campus

• Prioritize objectives and

identify healthy campus
initiatives
 International Opportunities
• Much need, especially in developing
countries

• Issues
Cultural differences; may need a

2nd language; topics for programs may be
very different than you have learned about in
the US

• Peace Corps an excellent opportunity

 Non-Traditional Health Education

Consumer marketplace

• Sales related to health & fitness

• Pharmaceuticals
• Fitness, health, & medical equipment
• Health-related books and materials

• Health in the larger surround: Media, TV,

Newspapers

• Tourism/Recreation
 Comparison of Major Settings
Setting Primary Mission Who is Served?
School Education Children/adolescents

Worksite Productivity; Profits Consumers of products and

services
Hospitals/Clinics Treat/Prevent illness and Patients
disease
Community Prevent, detect, and treat Public
illness
International Control of chronic and Targeted Regions
infectious disease

Other Settings Consumerism Public

What populations fall out of
bound from the major
settings?
 High Risk Populations
• Individuals alienated from neighborhoods and
communities
• Homeless
• Unemployed
• Out-of-school youth
• Those without health insurance or alternative
health care affiliations
• Those in other social institutions
– Criminal justice, mental health…